Pediatric heart transplantation has become an accepted method of treatment for certain pediatric heart disease. From July 1986 to January 1993, we performed 25 orthotopic pediatric heart transplantations at the University of Minnesota Hospital and Clinics in 16 male patients and nine female patients. The average age was 8.5 years with a range from 7 days to 18 years. Three of the patients were younger than 1 year of age. The indications for transplantation included congenital heart disease in six patients and cardiomyopathy in 19 patients. Four of the patients with congenital heart disease had previously undergone a cardiac surgical procedure. Two patients with cardiomyopathy had mechanical assist devices in place at the time of transplantation. Donor age ranged from 2 months to 36 years. The donor organ ischemic time ranged from 60 minutes to 329 minutes, with an average of 191 minutes. Follow-up ranged from 6 to 84 months. Overall, there were seven deaths (28%) in the patients undergoing transplantation. Of the seven deaths, four (16%) were early (within 30 days) and three (14.3%) were late. The four early deaths were a result of donor organ failure, and the three late deaths a result of acute rejection. The 2-year survival for patients with a minimum 24-month evaluation was 79% (15 of 19). Of 12 patients available for 5-year assessment, 75% (9 of 12) were alive and doing well at the time this article was written. Pediatric heart transplantation can provide good intermediate and long-term survival for selected pediatric patients.